CLARIDONTOWNSHIP

EMPLOYMENT APPLICATION

ADMINISTRATIVE

Instructions: Print clearly in black or blue ink. Answer all questions. Sign and date the application.

PERSONAL INFORMATION

Name (Last, First, Middle) / Home Phone Number
Address / Cell Phone Number
City/State/ ZIP Code / E-mail Address
Are you legally eligible for employment in the United States? / □Yes / □ No
Are you 18 years of age or older?
If not, do you have an employment/age certificate? / □Yes □ No
□Yes □ No

Are you applying for:□ Full-time□ Part-time□ Temporary

Position Appling For:

Availabilty

DAYS OF THE WEEK / HOURS BEGINNING / HOURS ENDING
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

What date are you available to start work?

EDUCATION/TRAINING

SCHOOLS / NAME/LOCATION / DATES ATTENDED / GRADUATE
Y or N / Years Completed/Field of Study
Secondary
College/University
Graduate/Professional
Trade/Vocational

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EMPLOYMENT APPLICATION

ADMINISTRATIVE

EMPLOYMENT HISTORY List last employment first, include summer or temporary jobs. Be sure all your experience or employers related to this job are listed here, in summary (following this section), or use an extra sheet of paper if necessary.

Name of employer / Name of last supervisor / Employment dates / Pay or Salary
Address / From:
To: / Start:
Final:
City, State, ZIP
Phone Number / Your Last Job Title
Email
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.
Name of employer / Name of last supervisor / Employment dates / Pay or Salary
Address / From:
To: / Start:
Final:
City, State, ZIP
Phone Number / Your Last Job Title
Email
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

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EMPLOYMENT APPLICATION

ADMINISTRATIVE

EMPLOYMENT HISTORY (continued)

Name of employer / Name of last supervisor / Employment dates / Pay or Salary
Address / From:
To: / Start:
Final:
City, State, ZIP
Phone Number / Your Last Job Title
Email
Reason for leaving (be specific)
List the jobs you held, duties performed, skills used or learned, advancements or promotions while you worked at this company.

May we contact your present employer?□ Yes □ No

Skills and Qualifications: Licenses, Skills, Training, Awards

References (Give the names of three persons not related to you.)

Name / Address / Phone / Occupation

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EMPLOYMENT APPLICATION

ADMINISTRATIVE

I certify that I have given true, accurate, and complete information on this form to the best of my knowledge. In the event confirmation is needed in connection with my work, I authorize educational institutions, associations, registration and licensing boards, and others to furnish whatever detail is available concerning my qualifications. I authorize investigation of all statements made in this application and understand that false information or documentation, or a failure to disclose relevant information may be grounds for rejection of my application and/or disciplinary action or dismissal if I am employed, and (or) criminal action. I further understand that dismissal upon employment shall be mandatory if fraudulent disclosures are given to meet position qualifications.

Signature

Print Name

Date

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